Patients did not have timely access to initial assessment and diagnosis.
There was a risk that high demand, unrelenting pressure and staff perception that they were providing a poor service would lead to a demoralised culture and a lack of service sustainability.
Call bells were not available in the majors cubicles and there was insufficient seating for patients waiting in reception and for relatives in the majors and resuscitation areas.
Staff did not always assess and respond to patient risks appropriately whilst they were waiting to be seen in thedepartment but leaders responded swi ly to address and mitigate these risks when we brought them to their attention.
Ongoing issues with the implementation of a new computer system meant staff did not always have the information they needed to deliver effective care.
The overcrowding in the department made it difficult for staff to protect the privacy and dignity of patients.
The Care Quality Commission (CQC) has today (Thursday 23 Feb) published its inspection report for urgent and emergency services at Queen’s Medical Centre (QMC), part of Nottingham University Hospital NHS Trust (NUH).
Inspectors visited QMC on 7, 8 & 11 December 2016. NUH has been rated ‘Good’ in the ‘Caring’, ‘Well-led’ and ‘Effective’ domains and ‘Requires Improvement’ for the ‘Safe’ and ‘Responsive’ domains. The Trust’s rating for urgent and emergency services is ‘Requires improvement.’ NUH’s overall rating (following its 2015 Trust-wide inspection, which was published in March 2016) remains ‘Good’.
Inspectors observed staff caring for patients with “compassion, patience and kindness.” The patients the CQC spoke to said they felt listened to and involved in their care and treatment.
This reinforces the feedback we routinely receive via other sources, including social media, our ‘friends and family’ test scores and patient experience websites; which tells us that the quality of care and services in our Emergency Department is generally good even though we know patients don’t always receive the timely care we would wish them to.
The Report recognises the culture of learning and continuous improvement. It also praises the service’s strong track record for good patient outcomes and safety, though inspectors were concerned about patients not receiving timely access to initial assessments and diagnosis and saw that observations on patients waiting for beds were not always being done as frequently as they should be.
The Report highlights that overcrowding in ED all too often impacts on the experience of our patients, with staff working in a department that was designed to see an average of 350 patients a day now consistently seeing 550 patients daily.
Caroline Shaw, NUH’s Chief Operating Officer, said: “The CQC made some helpful observations that have further informed where we need to make improvements, building on the work we are doing across the health and social care system with the support of the Emergency Care Improvement Programme. We have used these findings and concerns to accelerate improvements.
This includes enhancing our streaming service so that more patients with less serious injuries/illnesses are treated by primary care clinicians working on-site. Emergency nurse practitioners now work at the front door and stream the most unwell patients as a priority. We have introduced named nurses to ensure timely observations of patients waiting for beds and treatments in the main ED.
The A&E Delivery Board (chaired by NUH’s Chief Executive Peter Homa and attended by Nottinghamshire health and social care system leaders) is overseeing the system changes that are required to further improve performance against the national emergency access standard and thereby patient and staff experience.”
NUH’s overall Trust CQC inspection rating remains ‘Good’.